Date of Award

5-1-2026

Embargo Period

5-1-2026

Document Type

Dissertation

Degree Name

Doctor of Health Administration

Department

Health Administration

College

College of Health Professions

First Advisor

Kevin Keith Wiley

Second Advisor

Alexander Alekseyenko

Third Advisor

Joanna Rachel Jackson

Abstract

Disparities in patient portal use undermine equitable chronic disease management, particularly for adults with diabetes in rural and historically underserved communities. This explanatory sequential mixed-methods study examined the associations among trust in the healthcare system and patient portal use among U.S. adults, using nationally representative data from the Health Information National Trends Survey (HINTS) 2023 (N = 3,711), supplemented by semi-structured interviews with frontline healthcare providers. Bivariate analyses revealed that adults with diabetes reported lower trust (83% vs. 86%, p = 0.003) and lower portal use (62% vs. 66%, p = 0.014) compared to those without a diagnosis. Multivariate logistic regression identified age and income as the strongest independent predictors of diabetes status, with an unexpected non-linear income effect suggesting differential access to diagnosis at the lowest income levels. Trust did not emerge as an independent moderator in the adjusted model, though qualitative findings revealed that trust operates as a dynamic mechanism, shaped encounter by encounter and eroded by systemic inequities. Providers described structural barriers, including device incompatibility and data plan restrictions, as compounding contributors to portal non-use. Findings support the need for trust-centered, equity-informed digital health interventions that address both individual and systemic barriers to engagement among populations most burdened by diabetes.

Rights

Copyright is held by the author. All rights reserved.

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